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Presse Medicale (Paris, France : 1983) Dec 2019Pulmonary hypertension in pregnant women is associated with high mortality and morbidity despite significant improvement in prognosis. Women with pulmonary arterial... (Review)
Review
Pulmonary hypertension in pregnant women is associated with high mortality and morbidity despite significant improvement in prognosis. Women with pulmonary arterial hypertension (PAH) should be still advised against pregnancy and advised on effective contraceptive methods. Pregnancy may be manageable in women with well controlled PAH or mild pulmonary hypertension (sPAP<50mmHg). When women with PAH choose to continue their pregnancy, they need: management by a multidisciplinary team in an expert centre; continuation or early introduction of targeted PAH therapy; early planned delivery.
Topics: Delivery, Obstetric; Directive Counseling; Female; Humans; Maternal Mortality; Preconception Care; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Prenatal Care; Pulmonary Arterial Hypertension; Risk Factors; Vasodilator Agents
PubMed: 31679895
DOI: 10.1016/j.lpm.2019.08.007 -
BMC Pregnancy and Childbirth Oct 2021Pregnant teenagers in rural and regional areas experience distinct disadvantages, that are not simply a function of their age, and these have a substantial impact on...
BACKGROUND
Pregnant teenagers in rural and regional areas experience distinct disadvantages, that are not simply a function of their age, and these have a substantial impact on their health and that of their baby. Studies demonstrate that antenatal care improves pregnancy outcomes amongst pregnant women, especially adolescents. Understanding teenager's views and experiences of pregnancy and motherhood is important to ensure antenatal care meets young women's needs. This study explored teenage women's experiences and perceptions of barriers and facilitators to engaging in pregnancy care in rural and regional Victoria, Australia.
METHODS
Between February-October 2017, pregnant women aged ≤19 years were purposively recruited from one regional and two rural health services in Victoria. Semi-structured, face-to-face interviews guided by naturalistic inquiry were conducted and an inductive approach to analysis was applied.
RESULTS
Four key themes emerged from the analysis of the transcripts of 16 interviews: Valuing pregnancy care, Interactions with Maternity Service, Woman-centred care, and Support systems. Teenage women primary motivation to attend care was to ensure their baby's wellbeing and lack of engagement occurred when the relevance of antenatal care was not understood. Appointment flexibility and an accessible location was important; most participants were reliant on others for transport. Continuity of carer and respectful, non-judgement communication by staff was highly valued. Many young women had fractured families with pregnancy diminishing their social world, yet having a baby gave them purpose in their lives.
CONCLUSION
Maternity services and health professionals that provide flexible, adaptable women-centred care and support through pregnancy and early motherhood will assist young women's engagement in antenatal care.
Topics: Adolescent; Female; Health Personnel; Health Services Accessibility; Humans; Pregnancy; Pregnancy in Adolescence; Prenatal Care; Qualitative Research; Rural Health Services; Rural Population; Victoria; Young Adult
PubMed: 34629069
DOI: 10.1186/s12884-021-04137-1 -
Journal of the History of Medicine and... Jul 2020In the early to mid-twentieth-century United States, prenatal care helped reshape pregnancy by extending medical directives into the everyday life of pregnant women....
In the early to mid-twentieth-century United States, prenatal care helped reshape pregnancy by extending medical directives into the everyday life of pregnant women. What began with minimal strategies for a few women at high risk grew into a "lifestyle" for all expecting babies. Maternity manuals helped popularize this process. Studying revisions of a widely circulated and publicly funded manual, Prenatal Care, from the U.S. Children's Bureau between 1913 and 1983, shows that prenatal-care standards offered women healthy pregnancies on condition that they abandon older ways of understanding pregnancy and become maternity patients. Prenatal Care taught women to take positive steps to enhance outcomes, but a woman's active role in her own pregnancy was complicated by the fact that the guides made obedience to her doctor her primary responsibility.
Topics: History, 20th Century; Pregnant Women; Prenatal Care; United States
PubMed: 32417929
DOI: 10.1093/jhmas/jraa017 -
BMC Pregnancy and Childbirth Oct 2019Early, regular prenatal care utilization is an important strategy for improving maternal and infant health outcomes. The purpose of this study is to better understand...
BACKGROUND
Early, regular prenatal care utilization is an important strategy for improving maternal and infant health outcomes. The purpose of this study is to better understand contributing factors to disparate prenatal care utilization outcomes among women of different racial/ethnic and social status groups before, during, and after the Great Recession (December 2007-June 2009).
METHODS
Data from 678,235 Washington (WA) and Florida (FL) birth certificates were linked to community and state characteristic data to carry out cross-sectional pooled time series analyses with institutional review board approval for human subjects' research. Predictors of on-time as compared to late or non-entry to prenatal care utilization (late/no prenatal care utilization) were identified and compared among pregnant women. Also explored was a simulated triadic relationship among time (within recession-related periods), social characteristics, and prenatal care utilization by clustering individual predictors into three scenarios representing low, average, and high degrees of social disadvantage.
RESULTS
Individual and community indicators of need (e.g., maternal Medicaid enrollment, unemployment rate) increased during the Recession. Associations between late/no prenatal care utilization and individual-level characteristics (including disparate associations among race/ethnicity groups) did not shift greatly with young maternal age and having less than a high school education remaining the largest contributors to late/no prenatal care utilization. In contrast, individual maternal enrollment in a supplemental nutrition program for women, infants, and children (WIC) exhibited a protective association against late/no prenatal care utilization. The magnitude of association between community-level partisan voting patterns and expenditures on some maternal child health programs increased in non-beneficial directions. Simulated scenarios show a high combined impact on prenatal care utilization among women who have multiple disadvantages.
CONCLUSIONS
Our findings provide a compelling picture of the important roles that individual characteristics-particularly low education and young age-play in late/no prenatal care utilization among pregnant women. Targeted outreach to individuals with high disadvantage characteristics, particularly those with multiple disadvantages, may help to increase first trimester entry to utilization of prenatal care. Finally, WIC may have played a valuable role in reducing late/no prenatal care utilization, and its effectiveness during the Great Recession as a policy-based approach to reducing late/no prenatal care utilization should be further explored.
Topics: Adult; Birth Certificates; Economic Recession; Female; Health Services Accessibility; Humans; Medicaid; Patient Acceptance of Health Care; Pregnancy; Pregnancy Outcome; Pregnant Women; Prenatal Care; Reproductive History; Social Determinants of Health; Socioeconomic Factors; United States
PubMed: 31664939
DOI: 10.1186/s12884-019-2486-1 -
MCN. the American Journal of Maternal... 2020
Topics: Adult; Female; Humans; Pregnancy; Prenatal Care; American Indian or Alaska Native
PubMed: 32604190
DOI: 10.1097/NMC.0000000000000641 -
Women and Birth : Journal of the... Sep 2023Stillbirth is one of the most devastating pregnancy outcomes that families can experience. Previous research has associated a wide range of risk factors with stillbirth,... (Review)
Review
BACKGROUND
Stillbirth is one of the most devastating pregnancy outcomes that families can experience. Previous research has associated a wide range of risk factors with stillbirth, including maternal behaviours such as substance use, sleep position and attendance and engagement with antenatal care. Hence, some preventive efforts have been focused on tackling the behavioural risk factors for stillbirth. This study aimed to identify the Behaviour Change Techniques (BCTs) used in behaviour change interventions tacking behavioural risk factors for stillbirth such as substance use, sleep position, unattendance to antenatal care and weight management.
STUDY DESIGN
A systematic review of the literature was conducted in June 2021 and updated in November 2022 in five databases: CINHAL, Psyhinfo, SociIndex, PubMed and Web of Science. Studies published in high-income countries describing interventions designed in the context of stillbirth prevention, reporting stillbirth rates and changes in behaviour were eligible for inclusion. BCTs were identified using the Behaviour Change Technique Taxonomy v1.
RESULTS
Nine interventions were included in this review identified in 16 different publications. Of these, 4 interventions focused on more than one behaviour (smoking, monitoring fetal movements, sleep position, care-seeking behaviours), one focused on smoking, three on monitoring fetal movements and one on sleep position. Twenty-seven BCTs were identified across all interventions. The most commonly used was "Information about health consequences" (n = 7/9) followed by "Adding objects to the environment" (n = 6/9). One of the interventions included in this review has not been assessed for efficacy yet, of the remaining eight, three showed results in the reduction of stillbirth rates. and four interventions produced behaviour change (smoking reductions, increased knowledge, reduced supine sleeping time).
CONCLUSIONS
Our findings suggest that interventions designed to date have limited effects on the rates of stillbirth and utilise a limited number of BCTs which are mostly focused on information provision. Further research is necessary to design evidence base behaviour change interventions with a greater focus to tackle all the other factors influencing behaviour change during pregnancy (e.g.: social influence, environmental barriers).
Topics: Humans; Pregnancy; Female; Stillbirth; Behavior Therapy; Prenatal Care
PubMed: 37179243
DOI: 10.1016/j.wombi.2023.05.002 -
Clinical Radiology Sep 2021Fetal magnetic resonance imaging (MRI) has become a valuable adjunct to ultrasound (US) in diagnosing fetal abnormalities. This review is intended to highlight the... (Review)
Review
Fetal magnetic resonance imaging (MRI) has become a valuable adjunct to ultrasound (US) in diagnosing fetal abnormalities. This review is intended to highlight the contribution of MRI in parental counselling and perinatal treatment. A state-of-the-art fetal MRI protocol with experts of maternal-fetal medicine present in the MRI suite allows emphasis on patient-centred care and maximises therapeutic options.
Topics: Congenital Abnormalities; Female; Humans; Magnetic Resonance Imaging; Pregnancy; Prenatal Care; Prenatal Diagnosis
PubMed: 34112509
DOI: 10.1016/j.crad.2021.05.006 -
The Journal of Maternal-fetal &... May 2022A growing number of fetal procedures are performed at specialized fetal care centers for congenital problems that classically would have poor outcomes despite advanced... (Review)
Review
PURPOSE
A growing number of fetal procedures are performed at specialized fetal care centers for congenital problems that classically would have poor outcomes despite advanced postnatal management. Consistent fetal monitoring is integral to the safety of these challenging and innovative surgeries. However, standardization of fetal monitoring during various forms of fetal surgery has yet to be established.
MATERIALS AND METHODS
We searched all articles on literature platforms until August 2019 using the terms "fetal surgery," "fetal monitoring," and "fetal interventions." Titles and abstracts were screened by our coauthors to determine the type of fetal monitoring used in these cases.
RESULTS
The search identified 1,625 citations, of which the 50 citations considered most pertinent were included in this review.
CONCLUSIONS
Fetal monitoring during in utero fetal surgeries continues to be challenging because of limited physical fetal access and technological aspects. Innovations in fetal cardiac monitoring during fetal surgeries have the potential for continuous and high-fidelity hemodynamic and physiologic monitoring, with the goal of early detection and treatment of fetal compromise.
Topics: Female; Fetal Monitoring; Fetal Therapies; Fetoscopy; Fetus; Humans; Pregnancy; Prenatal Care
PubMed: 32429715
DOI: 10.1080/14767058.2020.1767575 -
Obstetrics and Gynecology Jul 2023To assess differences in maternal and child outcomes in studies comparing reduced routine antenatal visit schedules with traditional schedules.
OBJECTIVE
To assess differences in maternal and child outcomes in studies comparing reduced routine antenatal visit schedules with traditional schedules.
DATA SOURCES
A search was conducted of PubMed, Cochrane databases, EMBASE, CINAHL, and ClinicalTrials.gov through February 12, 2022, searching for antenatal (prenatal) care, pregnancy, obstetrics, telemedicine, remote care, smartphones, telemonitoring, and related terms, as well as primary study designs. The search was restricted to high-income countries.
METHODS OF STUDY SELECTION
Double independent screening was done in Abstrackr for studies comparing televisits and in-person routine antenatal care visits for maternal, child, health care utilization, and harm outcomes. Data were extracted into SRDRplus with review by a second researcher.
TABULATION, INTEGRATION, AND RESULTS
Five randomized controlled trials and five nonrandomized comparative studies compared reduced routine antenatal visit schedules with traditional schedules. Studies did not find differences between schedules in gestational age at birth, likelihood of being small for gestational age, likelihood of a low Apgar score, likelihood of neonatal intensive care unit admission, maternal anxiety, likelihood of preterm birth, and likelihood of low birth weight. There was insufficient evidence for numerous prioritized outcomes of interest, including completion of the American College of Obstetricians and Gynecologists-recommended services and patient experience measures.
CONCLUSION
The evidence base is limited and heterogeneous and allowed few specific conclusions. Reported outcomes included, for the most part, standard birth outcomes that do not have strong plausible biological connection to structural aspects of antenatal care. The evidence did not find negative effects of reduced routine antenatal visit schedules, which may support implementation of fewer routine antenatal visits. However, to enhance confidence in this conclusion, future research is needed, particularly research that includes outcomes of most importance and relevance to changing antenatal care visits.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42021272287.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Infant, Low Birth Weight; Obstetrics; Parturition; Premature Birth; Prenatal Care
PubMed: 37290105
DOI: 10.1097/AOG.0000000000005193 -
JAMA Oct 2023
Topics: Female; Humans; Pregnancy; Amnion; Infusions, Parenteral; Obstetric Surgical Procedures; Pregnancy Outcome; Prenatal Care
PubMed: 37847278
DOI: 10.1001/jama.2023.15927